Improving screening and follow-up for suicidal ideation and behaviors among Latinx youth in primary care

改善初级保健中拉丁裔青少年自杀意念和行为的筛查和随访

基本信息

批准号：
10608186
负责人：
Kiara Alvarez
金额：
$ 32.49万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-12 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10608186
关键词：
Address Administrator Adolescent Adopted Age Caring Cause of Death Certification Characteristics Child Child Rearing Childhood Climate Clinic Collaborations Communication Communities Community Health Community Health Aides Community Practice Consolidated Framework for Implementation Research Data Death Rate Development Disparity Early Intervention Educational Materials Effectiveness of Interventions Eligibility Determination Evidence based intervention Family Federally Qualified Health Center Feeling suicidal Female Focus Groups Future Goals Health Personnel Health Professional Health Promotion Health Services Hospitals Human Resources Immigrant Immigrant family Implementation readiness Interruption Intervention Interview Latina Latino Latinx Limited English Proficiency Linguistics Maps Medical Mental Health Mental Health Services Methods Modeling National Institute of Mental Health Nature Outcome Parents Patients Pilot Projects Population Prevention Primary Care Procedures Process Protocols documentation Provider Randomized, Controlled Trials Reporting Resources Role Safety Self Efficacy Services Site Strategic Planning Structure Suicide Suicide attempt Suicide prevention Supervision System Testing Time Series Analysis Training Underserved Population Visit Well Child Visits Work Youth acceptability and feasibility bilingualism care coordination collaborative care community clinic cost effectiveness evaluation evidence base experience follow-up health care service health care settings implementation protocol improved literacy male medical specialties member mental health education patient centered medical home pediatrician peer support pilot trial practice setting preference prevent preventive intervention primary care practice primary care setting programs psychoeducation psychoeducational reducing suicide screening service delivery service gap social stigma suicidal behavior suicidal morbidity suicidal risk suicide model suicide rate system-level barriers

项目摘要

Project Summary/Abstract The objective of this proposal is to develop and pilot a systems-level strategy in pediatric primary care to enhance identification and management of suicidal ideation and behavior in Latinx youth, particularly those in immigrant families with parents who have limited English proficiency (LEP). We will focus on the use of trained community health workers (CHWs) to increase clinic capacity and quality of suicide risk screening and early intervention, with a focus on safety planning, parent psychoeducation and care coordination. Our specific aims are 1: To develop site-specific implementation protocols for the integration of CHWs into SIB screening and safety planning for Latinx youth and their families; 2: To pilot the implementation of the program in a six-month open trial in four pediatric primary care practices representing a range of usual practice settings; and 3: To engage a stakeholder network to explore barriers and facilitators, including costs and billing strategies, to implementation of this approach across a broad range of pediatric primary care settings. In Aim 1, we will use Implementation Mapping, a systematic process incorporating the perspectives of users (e.g., families), implementers (e.g., clinic staff), adopters (e.g. clinic administrators) and sustainers (e.g. healthcare service delivery experts and payors) to guide development of strategies to adopt, implement and maintain an evidence-based intervention in the four participating pediatric practices. In Aim 2, we will assess feasibility, acceptability, and impact on organizational (e.g., increase in screening and CHW referral, engagement in follow-up mental health visits) and patient-level outcomes (e.g., improved family functioning, parenting self-efficacy). Quantitative data (e.g., changes in rates of screening) will be examined using an interrupted time series analysis. In Aim 3, we will conduct semi-structured interviews with stakeholders and convene the stakeholder network to develop an implementation plan for a larger trial. We will then integrate pilot trial and qualitative data using mixed methods analysis to assess feasibility and acceptability at the organizational, provider, and patient levels and convene to develop an implementation plan for a larger trial. Successful completion of this deployment-focused pilot study would prepare us for a future multi-site cluster randomized controlled trial assessing the effectiveness of the implementation of suicide prevention interventions delivered by CHWs in health care settings on rates of suicidal ideation and behavior for Latinx youth in pediatric primary care, with the long- term goal of addressing mental health service disparities and preventing youth suicide.

项目摘要/摘要该提案的目的是制定和试行小儿的系统级策略初级保健以增强自杀构想和行为的识别和管理拉丁裔青年，尤其是那些在移民家庭中，父母有限的英语熟练程度（LEP）。我们将专注于使用训练有素的社区卫生工作者（CHW）提高自杀风险筛查和早期干预的诊所能力和质量，重点关于安全计划，父母心理教育和护理协调。我们的具体目标是1：开发特定地点的实施协议，以将CHW集成到SIB筛选中和拉丁裔青年及其家人的安全计划； 2：试行实施在四个儿科初级保健实践中进行的为期六个月的公开试验中的计划，代表了一系列通常的练习环境； 3：参与利益相关者网络探索障碍和促进者，包括成本和计费策略，以实施这种方法各种各样的小儿初级保健环境。在AIM 1中，我们将使用实施映射，一个系统的过程结合了用户的观点（例如家庭），实施者（例如，诊所工作人员），采用者（例如诊所管理员）和维持者（例如，医疗保健服务交付专家和付款人）指导制定采用，实施和维护的策略基于证据的干预措施对四种参与的小儿实践。在AIM 2中，我们将评估可行性，可接受性和对组织的影响（例如，筛选和chw的增加推荐，参与后续心理健康访问）和患者水平的结果（例如，改善家庭功能，育儿自我效能）。定量数据（例如，率的变化筛选）将使用中断的时间序列分析来检查。在AIM 3中，我们将进行与利益相关者的半结构化访谈并召集利益相关者网络开发更大审判的实施计划。然后，我们将整合试点试验和定性数据使用混合方法分析来评估组织的可行性和可接受性，提供者，以及患者级别，并召集制定更大试验的实施计划。成功完成这项以部署为中心的试点研究将为我们做好准备未来的多站点群集随机对照试验评估了 CHW在医疗保健环境中提供的预防自杀性干预措施的实施在小儿初级保健中，拉丁裔青年的自杀念头和行为率很长解决精神卫生服务差异和预防青年自杀的术语目标。